Is there any such thing as a safe sleeping pill Experts warn they raise the risk of Alzheimer's
23:18 GMT, 8 October 2012
When her GP suggested putting her on sleeping pills, Sarah Graham didn’t think twice. The high-powered investment banker spent much of her time travelling across time zones and was constantly battling to get a decent night’s sleep.
‘I’d arrive somewhere and go into an important meeting after only a few hours’ sleep, and it was starting to catch up with me. I couldn’t function properly,’ says Sarah (not her real name). ‘The GP said to use them only when I really needed them.’
And to begin with the pills did, indeed, seem to help — almost immediately, the then 25-year-old began to feel much more focused and alert during the day.
It took a year for one woman to kick her sleeping pill habit, with the help of the clinic
Yet within a few months their effectiveness began to drop off — instead of just one 5mg tablet, Sarah needed two for the same benefit. Soon she was taking them every day, sometimes three tablets at a time.
Friends and family noticed changes in her behaviour, complaining she was anxious and ‘ratty’, and her two-year relationship ended. ‘I also started having problems with my short-term memory,’ says Sarah.
Despite taking ever-larger doses, Sarah was not sleeping that well. ‘It seemed as if I was getting only three or four hours of broken sleep a night.’
As her body became used to the drug, Sarah needed more and more to drop off.
Embarrassed to ask her GP for more, she began buying zolpidem on the internet and from pharmacies when her job took her outside Europe. The standard dose for zolpidem is 5-10mg taken once a day before bed — three years after starting the drug, Sarah was taking up to eight 10mg pills a day.
‘I was so groggy and erratic I couldn’t do my job. I had to admit something was wrong,’ she says.
Yet when her GP discovered she’d been getting extra pills elsewhere, he refused to help. In desperation, Sarah, now 34, checked into an NHS centre for alcoholics and drug abusers.
‘It was the most harrowing experience I’d ever had. Some of the people there had been injecting heroin and sleeping rough. All the doors were locked as you went in and out.’
It took a year for Sarah to kick her sleeping pill habit, with the help of the clinic. She has quit her globe-trotting job and works with charities.
Her memory is not so good, she confesses, and she doesn’t handle stress well. ‘I have no doubt the zolpidem is to blame,’ she says.
Doctors handed out ten million prescriptions for sleeping pills last year in England alone.
Around half were for so-called ‘Z’ drugs, a group of pills with names all beginning with ‘Z’ (zopiclone, zaleplon and zolpidem — the drug Sarah was taking).
The rest of the prescriptions were for tranquillisers called benzodiazepines (benzos). The best known is Valium (‘mother’s little helper’), which was launched in the Sixties and is known by its generic name, diazepam. Another popular benzo is temazepam, which is used for insomnia.
Not only are these sleeping pills highly addictive, they’re being linked to an increased risk of cancer and premature death.
A new study revealed that people over 65 who’d taken benzos or Z drugs had a 50 per cent increased risk of developing Alzheimer’s.
Some experts are asking whether the idea of tampering with the brain to improve sleep is inherently misguided and risky, because we still don’t know enough about how the brain works — prompting the question of whether there is such a thing as a safe sleeping pill.
Benzos and the newer Z drugs work by increasing the production of GABA, a chemical in the brain that dampens down activity in the central nervous system, making you feel relaxed and drowsy.
As early as the Eighties it was recognised that benzos are highly addictive. When you boost any brain chemical, your system adapts to the rise, so you keep needing more for the same effect (a similar thing happens with opium-based drugs, such as codeine and heroin, which boost natural pain-killing opioids).
Yet even now there are as many as 1.5 million Britons addicted to benzos. Concerns about the addictiveness of benzos led to the development, in the Nineties, of Z drugs — said to be less addictive and with fewer side-effects.
As a result, many doctors began phasing out benzos for insomnia and using Z drugs. Now experts warn that Z drugs are just as addictive. And both drug types are being used for far too long.
Though sleeping pills are meant to be taken only short term, research from the King’s Fund in London last summer found one in five sleeping pill prescriptions were longer than eight weeks.
One solution to sleep problems is counselling. (Picture posed by model)
A recent study found people taking benzos or Z drugs had a higher risk of developing cancer and as much as a five-times greater chance of dying sooner than those who had never taken them.
‘The only other legally available drug with a comparable risk to the benzodiazepines and the Z drugs is cigarettes — they should have a similar level of warning on them,’ says Daniel Kripke, professor of psychiatry emeritus at the University of California, San Diego, who led the study of 33,000 people.
Despite their addictive qualities, experts say the drugs don’t work.
‘It might be OK to keep prescribing these drugs if they were really effective,’ says Professor Colin Espie, a psychologist and head of the Sleep Centre at the University of Glasgow.
‘You could decide that the benefits outweighed the risks. The problem is that they don’t even work.’
On average, sleeping pills help people fall asleep just 15 minutes faster and stay asleep 37 minutes longer. And one leading study, by the U.S. National Institutes of Health, found even less impressive results — with patients falling asleep only 12 minutes faster and sleeping just 11 minutes longer.
‘Researchers keep on finding serious problems with the drugs,’ says Professor Espie. ‘But because the doctors feel there is nothing else to offer, they feel obliged to keep handing them out.’
Janet Marshall’s story is a particularly shocking example.
She was 26 with four children when she arrived home one day and had what would now be called a panic attack. ‘The doctors put me on a benzo and that was it — I became an addict,’ she says.
Ten years later, complaining of not being able to sleep, Janet, from Wakefield, West Yorkshire, was given a prescription for the new Z sleeping pills, on top of the benzodiazepines she was taking.
‘No one told me it was the same type of drug,’ she says.
‘Soon I was taking 15 of the original pills a day plus two of the new ones at night.’
She started suffering many of the well-known side-effects of Z drugs — headaches, dizzy spells and fatigue. She was afraid to go out. Several times she tried to kill herself, once with 173 tablets.
Astonishingly, it was only five years ago that Janet’s GP conceded she might have a problem with sleeping pills, but still didn’t offer any help. Janet decided to go cold turkey. Remarkably, she managed to wean herself off the drugs.
‘Coming off was a nightmare,’ she says, recalling symptoms such as panic attacks and severe insomnia.
She has since sued her doctor and been awarded £25,000 in compensation. But as Janet, now 54, points out: ‘I’m never going to be back to my old self again.’
Though the problem with benzo addiction has been known for 25 years, there are still only a handful of places designed to help people come off sleeping pills and tranquillisers. Most are run by volunteer former benzo addicts and operate on shoestring budgets.
Meanwhile, the drug companies continue their search for an improved sleeping pill.
The latest, Suvorexant, due out later this year in the U.S., is said to affect a much smaller area of the brain than current drugs.
Manufacturers claim this allows you to fall asleep 40 per cent faster and sleep 40 per cent longer, without adverse effects.
Professor Kripke is not convinced. ‘It blocks a compound called orexin that is involved in sleep, but also controls appetite. Mice given the drug have put on a lot of weight.’
So is there such a thing as a safe sleeping pill
‘I’ve never seen evidence for it yet,’ says Professor Kripke. ‘Our understanding of the brain is still so basic that putting in powerful chemicals to do one thing has knock-on effects elsewhere.’
One solution, says Professor Kevin Morgan, director of the Clinical Sleep Research Unit at Loughborough University, is counselling.
‘Official NICE guidelines say the first line of treatment for sleeping problems should be non-drug counselling or therapy, and we have evidence to show it works and is cost-effective,’ he says.
The most effective type of counselling is cognitive behaviour therapy (CBT) — changing how you think and behave. In the past few years, thousands of therapists have been trained in CBT — anyone should be able to get treatment via their GP within two weeks.
Sarah wishes she’d had the chance to try CBT when she first had insomnia. ‘Addiction to those pills makes you lose something that never comes back,’ she says.